The typical co-pay for going to the emergency room is now more than $200. Is it always the best place to go if you have a cut or even a fracture that might be smallbut needs to be seen right away?Doctor Sonny Saggar talked with Elliot Weiler about how to decide when to go to the ER or somewhere else.1. WHEN SHOULD SOMEONE ALWAYS GO TO THE EMERGENCY ROOM OR CALL 911 FOR AN AMBULANCE?Hospital emergency rooms (ERs) are set up to focus on medical emergencies. As emergency physicians and nurses would love to tell you, the ER is NOT set up to focus on routine health care. Examples of true emergencies are:● Chest pain that could be a heart attack● A sudden numbness or weakness that could be a stroke● Not being able to breathe● Major trauma● Probably immediate hospitalization or immediate surgery● Uncertainty about whether it`s actually an emergency2. So here`s a silly question: why do ERs have Waiting Rooms with so many people waiting in them?If you think about it, an Emergency Room shouldn`t have a Waiting Room at all: why would you be asked to wait more than a couple of minutes if you have an emergency?Most ER physicians and nurses, even in busy trauma centers would be quick to tell you that over 80% of ER patients don`t actually have true medical emergencies, and could have been seen either at another place or even at a later date.The 911 service brings patients to the ER. To use the ER for anything other than a true emergency is just anti-social in my opinion.Remember the following, if you go to the ER for a problem that is not an emergency:● It will cost a lot more than it would at your doctor’s office or a walk-in clinic. A trip to the ER for an earache, for example, may cost three to four times as much as it would at your doctor’s office.● You will probably spend a lot more time there than you would at an urgent care or doctor’s office.● You will get care from a doctor or nurse practitioner who has probably never seen you before. It’s always best to get as much of your care as you can from a doctor who knows and understands you.Definitely go to the ER if you think you are having a medical emergency. That’s what the ER is for. Otherwise, call your primary care office first, or go to an urgent care clinic. It will save you money and time.3. What are the alternatives to the ER?Your Primary Care Physician or Primary Care Nurse Practitioner or your friendly neighborhood Urgent Care Clinic – and there are quite a lot of them around now.4. So what kind of situations can go to these alternative places instead of the ER?Urgent Cares can routinely take care of the following:● Sprains● Lacerations that need stitching up● Minor fractures and dislocations● X-rays● EKGs● Lab work● Nebulizer breathing treatments● Incision and drainage of abscesses● IV fluids and IV medications, and of course,● Transfer you to the ER if you do in fact come in with a real medical emergencyMost health problems are not emergencies. You may want to take care of the problem right away because you feel sick or uncomfortable, but often nothing bad is going to happen to you if you wait a bit. Then again, you don’t always know that for sure. Some problems that seem minor can become serious if you ignore them. And it may be even harder to know what to do when a child is sick.One good question to ask yourself is, “Am I thinking about going to the ER because it’s convenient or because it’s necessary?” If you are choosing the ER because you can get in without an appointment, keep in mind the high price you will pay for that convenience. You may also have to wait a long time before you are seen by a doctor. And you may have other options. You can always call your doctor’s office or a nurse line or another service, such as ContactADoc.com, for help.5. It`s been argued that many people go to the ER because they have no health insurance or any kind of assistance. Do these people have an alternative if they have a minor problem?Free Urgent Care Clinics have actually been recently opened by Grace Hill, Myrtle Hilliard Davis and Family Care Health Centers. These are federally-funded. They provide a great service and often have more resources than the private urgent care centers, such as CT and MRI scanners.The St. Louis Integrated Health Network is at stlouisihn.org, and helps coordinate how all the money is spent on the indigent and uninsured.These free clinics have been paid millions of dollars to ensure good access to health care for uninsured and underinsured children and adults through increased integration and coordination of a safety net for health care.These new free urgent care clinics are a tremendous development to take the burden away from the ERs in St. Louis and therefore, they actually help all of us in the community, and not just the uninsured.Integrated Health Network providers serve 200,000 individuals in the St. Louis region, according to their website.You can find out more at http://www.stlouisihn.org or by calling Grace Hill at 314-814-8778 or Myrtle Hilliard Davis at (314) 633-6363Dr. Saggar is an emergency physician, as well as an internist and urgent care specialist. He is also the Medical Director of the four privately owned St. Louis Urgent Care Clinics in St. Louis.

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